The hypothesis is that pyridostigmine will improve the safety factor of ganglionic neural transmission, while Droxidopa will replete the postganglionic neuron of norepinephrine (NE). This combination should result in enhanced orthostatic release of NE. The investigators have already demonstrated that pyridostigmine does not raise supine blood pressure.

The presence of orthostatic hypotension (fall in systolic BP greater than or equal to 30 mm Hg) is required for this study;

Autonomic testing and clinical evaluation demonstrates OH to be of neurogenic etiology.

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Please refer to this study by its ClinicalTrials.gov identifier: NCT01370512